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Free Minds & Free Markets

The Case for Legal Organ Sales

How legalizing the trafficking of human organs would save lives and protect the poor

Last month, 60-year-old Levy Rosenbaum pled guilty to trafficking in human organs, collecting more than $400,000 for arranging the sale of three kidneys. He faces up to 20 years in prison and is the first person in the U.S. to be convicted of organ trafficking.

As the prosecutor in the case, New Jersey's U.S. Attorney Paul Fishman, declared triumphantly: "A black market in human organs is not only a grave threat to public health, it reserves lifesaving treatment for those who can best afford it at the expense of those who cannot. We will not tolerate such an affront to human dignity."

But before you condemn Rosenbaum completely, think about this: There are three people out there, who before they paid Rosenbaum to get them new kidneys, were sick and dying. Now those same people are healthy and well. Indeed, standing before U.S. District Judge Anne Thompson, Rosenbaum didn’t sound like a bad guy at all, he sounded like a savior. “The son told me the father has kidney failure,” Rosenbaum explained. “I helped him.”

As kidney-donor Virginia Postrel sees it the Rosenbaum case is predictable. “This is exactly the situation the law was designed to prevent: a broker soliciting people to sell their kidneys. It's also exactly the situation the law creates: a broker getting a huge markup as a premium for breaking the law, rather than letting the donors receive an above-board price set by hospitals or insurers.” Harvard Economist Jeffrey Miron agrees: “The law prevents a practice that benefits both the donors and the recipients, so it creates a large temptation to break the law.”

But are Postrel and Miron actually suggesting that you could solve the black-market in kidneys if you just legalized sales, with prices determined by the market? Indeed they are; they aren’t alone, and with good reason.

Consider the sad data: There are 90,000 people waiting for a life-saving new organ. Of those on the waiting list, there were only 17,000 transplants last year. More than half of those were from dead donors (10,500), with another 3,000 from living donors. Meanwhile there were 28,000 names removed from United Network for Organ Sharing (UNOS) waiting list last year. What happened to the other 11,000 patients? A significant number—4,600—were removed from the list because the patients died waiting. And another 2,100 were deleted because the patient had become too sick to withstand a transplant. The current average wait time for a transplant is 3.5 years.

So there’s incredible demand for kidneys but there just aren’t enough donors. And one more technical matter: Transplants from live donors are more successful than transplants from dead donors. The National Kidney Foundation says about 94 percent of kidneys transplanted from cadavers are still functioning well at one year after surgery. But the results are even better for kidneys transplanted from living donors. One year after surgery, 98 percent of those kidneys were still functioning well.

Given the current situation, therefore, there’s a thriving black market for kidneys. But if you imagine that Rosenbaum’s $136,000 kidneys were transplanted into recipients in some back-alley, think again. The procedures all happened at reputable hospitals, Rosenbaum's attorneys said in a statement. According to Bloomberg, was procedure was done at Johns Hopkins Hospital in Baltimore.

As Postrel notes, in this case “there were no horror stories about people's health being harmed…The only harm was financial—the recipients paid much higher prices for the kidneys than they would have without the premium for breaking the law and the donors probably received a lower price than they would have in an above-board system.” Miron argues that a regulated, legal market would actually lower the cost per kidney because the donation pool would be expanded.

But that’s what Dr. Francis Delmonico, a transplant surgeon at Massachusetts General Hospital and the Medical Director of the New England Organ Bank, is worried about.

Delmonico acknowledges the kidney shortage, but he says legalizing the system will only end up exploiting the poor. “Sellers are disadvantaged because…they don’t really need to sell their organs, they need money,” he argues. Delmonico believes that any free-market system of selling kidneys would never be contained within, say, the United States, but rather would explode throughout the world where any regulation would simply not be enforced. The sellers, therefore, would be exploited, and would primarily come from the poorest countries, selling their organs to the highest bidder out of desperation.  

But Professor Nadey Hakim, transplant surgeon at St Mary's Hospital, London, argues that not legalizing sales could be an even bigger problem. "As this trade is going on anyway, why not have a controlled trade where if someone wants to donate a kidney for a particular price that would be acceptable? If it is done safely, the donor will not suffer."

And Sir Peter Bell, professor of surgery at the University of Leicester, suggests that “compensatory payments” should be made to relatives who donate the kidney of a family member, as a way of staving off the growing trade in organs from the developing world.

One of Delmonico’s colleagues meanwhile has a plan to regulate kidney sales.

Arthur J Matas, medical director of kidney transplants at University of Minnesota Medical Center argues that there can be a viable legal system with many of the same terms and precautions as the current voluntary system.

According to Matas’ plan the donor would get paid by the government or insurance company; the selection of who gets a transplant could still be done by a UNOS-type system; all donors would be fully evaluated (as they are now), and a legal system would include oversight, long-term follow-up, and “treatment of the donor with dignity and appreciation for providing a lifesaving gift.” Matas says “the payment could be a fixed sum and/or include term life insurance, long-term health insurance, reimbursement for travel expenses and time out of work, or a tax deduction.”

Matas makes one other important point about cost. Because dialysis is so much more expensive than a transplant, paid donation could be cost-neutral to the health care system.

What the debate comes down to is whether or not one believes in the power of markets. Public policy experts and the public at large will also have to get over their revulsion at the thought of selling organs to the highest bidder.

Abby Wisse Schachter authors Capitol Punishment, the New York Post’s politics blog.

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  • ||

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    ....because selling their body parts is better than the alternative, as we like to say. Because it makes us feel so much better.

  • ||

    ...people really makes the market fly.

    Because both are commodities.

  • ||

    iron, lumber, coal

    To be Consumed.

  • ||

    These are up for grabs, so +4 me! Woo hoo!

  • ||

    I grabbed at least some of them!

  • ||

    15 oz cans of Santorum? Yum yum.

  • ||

  • ||

    ...is so delicious.

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    ...if you don't chew.

  • ||

    +3.5 to Abby Wisse Schachter ?

    No! By Epi's rule, +3.5 to me!

  • Warty||

    Make it 3.75.

  • ||

    ...while the political dissent outcompetes the self-styled "competitors."

  • Warty||

    +1 for Metazoan

  • Warty||

    +1 for Metazoan

  • ||

    +1 to me again

  • Fist of Etiquette||

    But before you condemn Rosenbaum completely, think about this: There are three people out there, who before they paid Rosenbaum to get them new kidneys, were sick and dying. Now those same people are healthy and well.

    And there's three less people competing on the list.

    As some of you know, I was born with one kidney. Therefore, my comments are unimpeachable on the subject of organ transplant somehow. And I say that I hope the black market organ donors are also being charged! (But leave those poor organ recipients alone.)

  • ||

    "leave those poor organ recipients alone"

    No, it is our job to enforce the law consistently, not to judge the law itself.

  • ||

    We will also be seizing the assets to compensate the victims, The American People. Proceeds will go to the Treasury.

  • ||

    This issue is very dear to me, as I, too, would like to sell my organs. There is no way I will ever put myself in the chop shop while I am alive, but the only way I will allow my organs to be salvaged if I die is if they will be exchanged for some amount that will go to my estate or the party of my choice. People are suffering without my organs. I hope that one day the government will consider my position and legalize monetary exchange for organs. < /monocle >

  • ||

    Like Marxism, Libertarianism aspires, overtly or covertly, to reduce social life to ECONOMICS.

    Marxism of the Right
    by Robert Locke
    The American Conservative

    (you'll have to google for it, when libertarians care to ban only the very best.

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    +2 for me!

  • ||

    Doctor, give it to me straight...how long do I have left to gambol about the forest??

  • ||

    ...how do they work?

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    + for Sy

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    meanwhile.....there is something even more ghoulish going on today: President Obama dining on the rib bones of Osama Bin Laden aboard the death ship that dumped OBL's cadaver in the Indian Ocean. All while watching an on-board NCAA-college-hoops game.

    Of course, the public is not invited.

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    Organs are icky -- therefore, your friendly neighborhood government says you can't sell them. Tough shit, sick people.

  • ||

    Indians are icky -- therefore, your friendly neighborhood government says you they can't gambol. Tough shit, sick people.

  • ||

    +1 for Res

  • ||

    I always wanted to witness a schizo have a conversation with themself.

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    I hate the state1

    I love city-Statism (civilization!)

    Got enough Schizophrenia already?

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    + for Banjos

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    right before you sodomize an insurance agent from the city

  • ||

    Sweet, thanks Rectl! +1 for Banj!

  • ||

    sodomize rectal

    rectal sodomize banjos

    http://www.youtube.com/watch?v=HAYfGcH4QhM

  • ||

    +10 for Banjos!

  • Zeb||

    "themself" is not a word.

  • Zeb||

    Though perhaps it should be when you are talking about someone with multiple personalities.

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    (city-statism=civilization)

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  • ||

    Holy shit, I think this might constitute as a +4 for Zeb.

  • Zeb||

    Cool! And just 10 minutes ago I didn't even know I was playing.

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    How long it takes for city statist to eat the bones of democracy

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    Another one for Zeb!

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    Doctor, give it to me straight...how long do I have left to gambol about the forest??

    Look behind you, there's a grizzly mama...let's see how your nature boy skillz stack up!

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    ...by domesticated poodles.

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    A groovy +1!

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    Oh, and since you won't be needing those kidneys...(sharpens scalpel)

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    Government says it's icky and bad, so it's icky an bad -- stop questioning your betters, you rubes!

  • ||

    ...into parts to cannibalize for the hierarchical elite is so wonderful.

    Unless there's no way to profit. Then its not, of course.

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    are invisible to the elite when they sell the cigarettes in prison mess hall

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    +2 for Res

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    "themself" is not a word

    Meh.

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    Join in on the fun, Groovus.

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    (civilization = UNCIVILIZATION)

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    +1 for banjos!

  • ||

    Tell that half of these = not real

  • ||

    another +1 for banjos!

    damn..

  • ||

    A Reason Riot?

    Jeeesh, ugly shit.

  • ||

    Groovy +1!

  • ||

    This thread is full of fail.

  • ||

    I think that the ban on the sale of human organs is a good thing. In short, if you apply a commodity value to a human organ, then you introduce a system where a one person's organs can be forcibly harvested to satisfy a debt. There are some vital resources for which claiming ownership constitutes violence against persons. Clearly defined cases include air, sunlight. You can make the moral distinction that these resources are not produced in their finished state by human endeavor and therefore cannot be claimed as private property. I know, it sounds like I'm one step on a slippery slope from saying, fresh water, land and fossil fuels cannot rightfully be claimed as private property, so I'll couch my position by saying, we haven't gone down the road where one person can legally demand another's kidney and we really don't want to.

  • ||

    Are you kidding me? How does the unalienable right of having ownership over one's body translate into someone else claiming ownership of another's organs? If a free person chooses to sell their organs how is it any of yours (or mine) business?

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    As the gulf between incomes grow in America there are other areas that present problems that are similar and potentially worse. As the cost of health care soars 100,000,000 + Americans will not have access to care that will keep them healthy and alive. Also as the cost of education rises it closes the door to additional millions for opportunities to grow above their parents income levels. Then we have what amounts to a two tiered legal system whereby the 1% and elite elected are not subject to the same force of the law and the incarceration of millions continues to destroy millions of lives from another direction. Income differences are causing the deterioration of other service at a pace that will make the country a plutocracy before 2050. Then we will have what amounts to a third world view where the few enjoy a wonderful life and the many languish in poverty and despair. Whats more tragic is that many in the 99% do not think they will ever be subject to the same downward trend of the 99% and when they arrive at the bottom they will be dumbfounded at their myopia and apathy!

  • grotto213||

  • onlinefashion||

    Very nice better in future I hope.
    Thanks.

  • onlinefashion||

    Very nice better in future I hope.
    Thanks.
    online fashion

  • ||

    ABBY, you are my heroine. Finally, a writer with the guts to use the word "pled" instead of "pleaded."

    On a side note, I would like to file a complaint regarding the spell checker in Reason's comment box which refuses to recognize "pled" as a real word. Have we bastardized the English language to the extent that we no longer recognize real words?

  • ||

    What the debate comes down to is that if I'm legally proscribed from selling off the parts of my own body, then I don't really OWN my own body. And if I don't, then who does? (Rhetorical, although some genius will no doubt spell it out.)

    In other news, what the hell happened to this place? You're not half as cute as you think you are.

  • jason||

    Its a new kind of criminal case the organs trafficking now he may need a good criminal solicitor.

  • download games||

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  • download games||

    In other news, what the hell happened to this place? You're not half as cute as you think you are.

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